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病例介绍患者男性,50岁。因不明原因胸闷、憋气50天,双下肢浮肿40天,加重4天,拟诊为结核性心包炎入院。体查:脉压差2.7KPa,颈静脉怒张,右上肢静脉压2.9KPa,心界向两则扩大,心音低钝,律整,无杂音,双下肢轻度水肿。心电图示各导联低电压;二维B超示大量心包积液;X摄片示心影向左右扩大,心缘不规则,无钙化。多次心包穿刺共抽出血性液体2600ml,经病理检查及抗酸染色未发现瘤细胞及结核菌。心包穿刺抽液后自觉症状好转,二维B超复查见心包增厚,积液消失。于1990年1月8日在全麻下行部分心包剥脱切除术。术中见心脏大,搏动弱,心包增厚约0.5cm～0.7cm,灰白色,组织脆弱,易撕脱,有多个粟粒样结节,部分向心肌内嵌入。心肌紫红色,搏动无力,未发现肿大淋巴结。切除部分心包,测右上肢静脉压降至1.3KPa。病理诊断:心包间皮肉瘤。术后7天发生顽固性心衰,2周后死于多器官衰竭。
Case presentation Male patient, 50 years old. Due to unexplained chest tightness, hernia for 50 days, bilateral lower extremity edema for 40 days, and an increase of 4 days, she was diagnosed with tuberculous pericarditis. Physical examination: pulse pressure difference 2.7KPa, jugular vein engorgement, right upper limb venous pressure 2.9KPa, the heart of the community to expand two, low heart sound blunt, neat, no noise, mild edema of both lower extremities. Electrocardiogram shows the low voltage of the leads; 2D B-mode ultrasound shows a large amount of pericardial effusion; X-photograph shows the heart shadow expanding to the left and right, the heart margin is irregular, and there is no calcification. A total of 2600 ml of hemorrhagic fluid was drawn from the pericardial puncture. No pathological examination and acid-fast staining revealed tumor cells and tubercle bacilli. The symptoms of the pericardial puncture fluid improved, and the two-dimensional B-ultrasound showed thickening of the pericardium and the effusion disappeared. On January 8, 1990, partial pericardial stripping was performed under general anesthesia. During the operation, the heart was large, the pulsation was weak, the pericardium was thickened by about 0.5cm to 0.7cm, grayish white, and the tissue was fragile and easily avulsed. There were multiple miliary nodules and some were embedded in the myocardium. Myocardium purple, beating power, no enlarged lymph nodes. A portion of the pericardium was removed and the venous pressure in the right upper limb was reduced to 1.3 KPa. Pathological diagnosis: pericardial mesothelioma. Intractable heart failure occurred 7 days after surgery and died of multiple organ failure 2 weeks later.